Provider Demographics
NPI:1669631438
Name:EUGENIUS SBC ANG, MD PC
Entity Type:Organization
Organization Name:EUGENIUS SBC ANG, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLDRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-265-0229
Mailing Address - Street 1:PO BOX 3705
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48106-3705
Mailing Address - Country:US
Mailing Address - Phone:517-423-7481
Mailing Address - Fax:517-423-1921
Practice Address - Street 1:200 E RUSSELL RD
Practice Address - Street 2:STE B
Practice Address - City:TECUMSEH
Practice Address - State:MI
Practice Address - Zip Code:49286-2072
Practice Address - Country:US
Practice Address - Phone:517-423-7481
Practice Address - Fax:517-423-1921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301032535207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104992888Medicaid
MI1104610942OtherBCBS OF MI
MI104992888Medicaid